12 U.S. HEALTH INSURANCETERMS YOU NEED TO KNOW   That Cost You Money
Major Disclaimer        I am not an attorney –        nor do I play one on TV        The following guide does          not...
Does your health insurance             Confuse you?             Bore you?             All of the above?
All you want to know is                    how much will                      it cost –                        right?
about 12 healthinsurance terms
about 12 healthinsurance termsand how they costyou money
Keeping it simple: 3 categories   Money    Provider    Plan   Terms     Terms     Terms
MONEYTERMS
#1 – PREMIUM                      THE PURCHASE                      PRICE FOR HEALTH                      INSURANCE   The ...
Do you have health insurance                through your                employer?
Do you have health insurance                 through your                 employer?      Or do you purchase      your own?
If you purchase your own           Sorry you pay the entire           premium cost                  At least for now
If your employer offers coverage  look for health insurance term #2
#2 – CONTRIBUTIONS/COST-SHARING           THE AMOUNT YOUR EMPLOYER           CONTRIBUTES TO THE COST           OF THE PREM...
There is no law   requiring your   employer to   contributeAt least for now
#3 – DEDUCTIBLE                     THE AMOUNT YOU                     PAY BEFORE YOUR                      INSURANCE PAYS...
Review your health plan booklet       Deductible        applies
#4 – COPAYMENT/COINSURANCETHE AMOUNT YOU PAYBASED ON THE TYPE OFHEALTH CARE RECEIVED
#5 – OUT-OF-POCKET LIMITTHE MAXIMUM YOU PAY ON COVERED SERVICES BEFORE YOUR INSURANCE PAYS 100%
#1 – PREMIUM        #2 – CONTRIBUTIONS OR             COST SHARINGMONEY   #3 – DEDUCTIBLETERMS   #4 – COPAYMENT OR        ...
PROVIDER TERMS
#6 – IN-NETWORK   SERVICES           HEALTH CARE RECEIVED           FROM A PROVIDER WHO HAS           A CONTRACT WITH YOUR...
#7 – OUT-OF-NETWORK   SERVICES              TREATMENT FROM              PROVIDERS WHO DO              NOT PARTICIPATE IN  ...
Why should you care?                  Visiting network                  providers keeps                  money in your    ...
#8 – PRIMARY CARE PHYSICIAN            A PHYSICIAN WHO             MANAGES YOUR OVERALL             HEALTH CARE           ...
Your health plan may requireThomas Jones, MDGeneral Practitioner   you select a primary care                       physici...
Your health plan may requireThomas Jones, MDGeneral Practitioner   you select a primary care                       physici...
If you don’t get the referral    it could cost you    – big time
#6 – IN-NETWORKPROVIDER   #7 – OUT-OF-NETWORK TERMS     #8 – PRIMARY CARE                PHYSICIAN
PLANTERMS
#9 – COVERED   SERVICES                   LIST OF ELIGIBLE                    SERVICES FOR                    BENEFITS UND...
#10 – MAXIMUM    ALLOWANCE   THE HIGHEST DOLLAR AMOUNT YOUR   HEALTH PLAN PAYS FOR A SERVICE
You could be left holding the bag          for charges from     an out-of-network provider
#11 – EXCLUSIONS AND LIMITATIONS               LIST OF NON-COVERED               SERVICES OR THOSE WITH               BENE...
#12 – BRAND   VS. GENERIC DRUGS            DRUG WITH BRAND NAME            THAT IS PROTECTED BY   Brand™   PATENT    Drug
#12 – BRAND    VS. GENERIC DRUGS            DRUG WITH BRAND NAME             THAT IS PROTECTED BY   Brand™    PATENT    Dr...
Generic alternative saves moneyAsk your physician about generic drugs
#9 – COVERED SERVICES        #10 – MAXIMUM PLAN         ALLOWANCE        #11 – EXCLUSIONS ANDTERMS         LIMITATIONS    ...
MONEY   TERMS1. PREMIUM2. CONTRIBUTIONS   – COST SHARING3. DEDUCTIBLE4. COPAYMENT –   COINSURANCE5. OUT-OF-POCKET  LIMIT
MONEY             PROVIDER   TERMS              TERMS1. PREMIUM          6. IN-NETWORK2. CONTRIBUTIONS    7. OUT-OF-   – C...
MONEY             PROVIDER             PLAN   TERMS              TERMS              TERMS1. PREMIUM          6. IN-NETWORK...
Learn health               Check your     Save insurance               health plan   money!   terms
Questions?   Ask your employer’s             human resource             professional
Questions?        Ask your employer’s                  human resource                  professional  Or your health insura...
Legal stuffNotice of Disclaimer –Cathy Miller is not an attorney or health careprovider and cannot provide legal or health...
Download ebook 12 U.S. Health Insurance Terms You Need to         Know: That Cost You Money www.SimplyStatedHealthCare.com...
Cathy Miller, Business Writer        Business site: www.SimplyStatedBusiness.com       Health care blog:www.SimplyStatedHe...
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12 U.S. Health insurance terms

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An overview of 12 common U.S. health insurance terms that could mean money out of our pocket.

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12 U.S. Health insurance terms

  1. 1. 12 U.S. HEALTH INSURANCETERMS YOU NEED TO KNOW That Cost You Money
  2. 2. Major Disclaimer I am not an attorney – nor do I play one on TV The following guide does not constitute legal advice.
  3. 3. Does your health insurance Confuse you? Bore you? All of the above?
  4. 4. All you want to know is how much will it cost – right?
  5. 5. about 12 healthinsurance terms
  6. 6. about 12 healthinsurance termsand how they costyou money
  7. 7. Keeping it simple: 3 categories Money Provider Plan Terms Terms Terms
  8. 8. MONEYTERMS
  9. 9. #1 – PREMIUM THE PURCHASE PRICE FOR HEALTH INSURANCE The higher the level of coverage – the higher the premium
  10. 10. Do you have health insurance through your employer?
  11. 11. Do you have health insurance through your employer? Or do you purchase your own?
  12. 12. If you purchase your own Sorry you pay the entire premium cost At least for now
  13. 13. If your employer offers coverage look for health insurance term #2
  14. 14. #2 – CONTRIBUTIONS/COST-SHARING THE AMOUNT YOUR EMPLOYER CONTRIBUTES TO THE COST OF THE PREMIUM
  15. 15. There is no law requiring your employer to contributeAt least for now
  16. 16. #3 – DEDUCTIBLE THE AMOUNT YOU PAY BEFORE YOUR INSURANCE PAYS Think car insurance
  17. 17. Review your health plan booklet Deductible applies
  18. 18. #4 – COPAYMENT/COINSURANCETHE AMOUNT YOU PAYBASED ON THE TYPE OFHEALTH CARE RECEIVED
  19. 19. #5 – OUT-OF-POCKET LIMITTHE MAXIMUM YOU PAY ON COVERED SERVICES BEFORE YOUR INSURANCE PAYS 100%
  20. 20. #1 – PREMIUM #2 – CONTRIBUTIONS OR COST SHARINGMONEY #3 – DEDUCTIBLETERMS #4 – COPAYMENT OR COINSURANCE #5 – OUT-OF-POCKET LIMIT
  21. 21. PROVIDER TERMS
  22. 22. #6 – IN-NETWORK SERVICES HEALTH CARE RECEIVED FROM A PROVIDER WHO HAS A CONTRACT WITH YOUR HEALTH PLAN
  23. 23. #7 – OUT-OF-NETWORK SERVICES TREATMENT FROM PROVIDERS WHO DO NOT PARTICIPATE IN YOUR HEALTH PLAN’S CONTRACTED GROUP
  24. 24. Why should you care? Visiting network providers keeps money in your pocket
  25. 25. #8 – PRIMARY CARE PHYSICIAN A PHYSICIAN WHO MANAGES YOUR OVERALL HEALTH CARE Often your “family doctor”
  26. 26. Your health plan may requireThomas Jones, MDGeneral Practitioner you select a primary care physician (PCP)
  27. 27. Your health plan may requireThomas Jones, MDGeneral Practitioner you select a primary care physician (PCP) and receive referrals to specialists from your PCP
  28. 28. If you don’t get the referral it could cost you – big time
  29. 29. #6 – IN-NETWORKPROVIDER #7 – OUT-OF-NETWORK TERMS #8 – PRIMARY CARE PHYSICIAN
  30. 30. PLANTERMS
  31. 31. #9 – COVERED SERVICES LIST OF ELIGIBLE SERVICES FOR BENEFITS UNDER YOUR HEALTH PLAN
  32. 32. #10 – MAXIMUM ALLOWANCE THE HIGHEST DOLLAR AMOUNT YOUR HEALTH PLAN PAYS FOR A SERVICE
  33. 33. You could be left holding the bag for charges from an out-of-network provider
  34. 34. #11 – EXCLUSIONS AND LIMITATIONS LIST OF NON-COVERED SERVICES OR THOSE WITH BENEFIT RESTRICTIONS UNDER YOUR HEALTH PLAN
  35. 35. #12 – BRAND VS. GENERIC DRUGS DRUG WITH BRAND NAME THAT IS PROTECTED BY Brand™ PATENT Drug
  36. 36. #12 – BRAND VS. GENERIC DRUGS DRUG WITH BRAND NAME THAT IS PROTECTED BY Brand™ PATENT Drug SAME ACTIVE INGREDIENTS AS BRAND DRUG
  37. 37. Generic alternative saves moneyAsk your physician about generic drugs
  38. 38. #9 – COVERED SERVICES #10 – MAXIMUM PLAN ALLOWANCE #11 – EXCLUSIONS ANDTERMS LIMITATIONS #12 – BRAND VS GENERIC DRUGS
  39. 39. MONEY TERMS1. PREMIUM2. CONTRIBUTIONS – COST SHARING3. DEDUCTIBLE4. COPAYMENT – COINSURANCE5. OUT-OF-POCKET LIMIT
  40. 40. MONEY PROVIDER TERMS TERMS1. PREMIUM 6. IN-NETWORK2. CONTRIBUTIONS 7. OUT-OF- – COST SHARING NETWORK3. DEDUCTIBLE 8. PRIMARY CARE4. COPAYMENT – PHYSICIAN COINSURANCE5. OUT-OF-POCKET LIMIT
  41. 41. MONEY PROVIDER PLAN TERMS TERMS TERMS1. PREMIUM 6. IN-NETWORK 9. COVERED2. CONTRIBUTIONS 7. OUT-OF- SERVICES – COST SHARING NETWORK 10. MAXIMUM3. DEDUCTIBLE 8. PRIMARY CARE ALLOWANCE4. COPAYMENT – PHYSICIAN 11. EXCLUSIONS & COINSURANCE LIMITATIONS5. OUT-OF-POCKET 12. BRAND VS LIMIT GENERIC DRUGS
  42. 42. Learn health Check your Save insurance health plan money! terms
  43. 43. Questions? Ask your employer’s human resource professional
  44. 44. Questions? Ask your employer’s human resource professional Or your health insurance agent or representative
  45. 45. Legal stuffNotice of Disclaimer –Cathy Miller is not an attorney or health careprovider and cannot provide legal or health care advice.The information provided is for your general background only, and isnot intended to constitute legal or health care advice as to yourspecific circumstances.We recommend you review legislation with legal counsel and visityour physician for health care issues.Photo Credits: BigStock Photo
  46. 46. Download ebook 12 U.S. Health Insurance Terms You Need to Know: That Cost You Money www.SimplyStatedHealthCare.com/Free-Stuff
  47. 47. Cathy Miller, Business Writer Business site: www.SimplyStatedBusiness.com Health care blog:www.SimplyStatedHealthCare.com
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